Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 01050112A | IN |
NPI | 1053478495 |
---|---|
Provider Name | Dr. Heidi M Dunniway |
First Address | Belfast, ME 04915-4021 |
Second Address | Boonville, IN 47601-2204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 23/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200221210 | (05) | IN |
G98566 | (02) | IN |